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General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries
KT. Jungo, S. Mantelli, Z. Rozsnyai, A. Missiou, BG. Kitanovska, B. Weltermann, C. Mallen, C. Collins, D. Bonfim, D. Kurpas, F. Petrazzuoli, G. Dumitra, H. Thulesius, H. Lingner, KL. Johansen, K. Wallis, K. Hoffmann, L. Peremans, L. Pilv, MP....
Language English Country Great Britain
Document type Journal Article, Research Support, Non-U.S. Gov't
Grant support
407440_167465
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
RP 2014-04-026
National Institute for Health Research (NIHR) Applied Research Collaborations (West Midlands), the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice
NLK
BioMedCentral
from 2001-01-12
BioMedCentral Open Access
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Directory of Open Access Journals
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Free Medical Journals
from 2001
PubMed Central
from 2001
Europe PubMed Central
from 2001
ProQuest Central
from 2009-01-01
Open Access Digital Library
from 2001-01-01
Open Access Digital Library
from 2001-08-01
Open Access Digital Library
from 2001-01-01
Medline Complete (EBSCOhost)
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Health & Medicine (ProQuest)
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ROAD: Directory of Open Access Scholarly Resources
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Springer Nature OA/Free Journals
from 2001-12-01
- MeSH
- Activities of Daily Living MeSH
- Deprescriptions * MeSH
- Humans MeSH
- Multimorbidity MeSH
- Polypharmacy MeSH
- General Practitioners * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
Clinical Medicine Faculty of Medicine and Health Technology Tampere University Tampere Finland
Danish College of General Practitioners Copenhagen Denmark
Department of Clinical Sciences Centre for Primary Health Care Research Lund University Malmö Sweden
Department of Family Medicine Medical Faculty University of Ljubljana Ljubljana Slovenia
Department of Family Medicine Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
Department of Family Medicine Semmelweis University Budapest Hungary
Department of Family Medicine University of Tartu Tartu Estonia
Department of General Practice Faculty of Medicine University of Leipzig Leipzig Germany
Department of Medical Informatics Hôpital Européen Georges Pompidou AP HP Paris France
Department of Medicine and Optometry Linnaeus University Kalmar Sweden
Department of Nursing and Midwifery University Antwerp Antwerp Belgium
Department of Primary and Interdisciplinary Care University Antwerp Antwerp Belgium
Department of Public Health and Primary Care Leiden University Medical Center Leiden the Netherlands
Dom zdravlja Zagreb Centar Zagreb Croatia
Faculty of Medicine Department of Family Medicine Riga Stradiņs University Riga Latvia
Family Medicine Department Medical School University of Tuzla Tuzla Bosnia and Herzegovina
Family Medicine Department Wroclaw Medical University Wrocław Poland
Hannover Medical School Center for Public Health and Healthcare Hannover Germany
Hospital Israelita Albert Einstein São Paulo Brazil
Institute for General Practice University of Duisburg Essen University Hospital Essen Essen Germany
Institute of General Practice and Family Medicine University of Bonn Bonn Germany
Institute of Primary Health Care University of Bern Bern Switzerland
Irish College of General Practitioners Dublin Ireland
Primary Care Clinical Unit the University of Queensland Brisbane Australia
Primary Community and Social Care Keele University Keele Staffordshire ST5 5BG United Kingdom
Romanian Society of Family Medicine Bucharest Romania
SSLMG Societé Scientifique Luxembourgois en Medicine generale Luxembourg City Luxembourg
References provided by Crossref.org
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